Structured feedback from patients as an educational tool for breaking bad news in intensive care: a qualitative study.

Abstract

Breaking bad news (BBN) is a critical yet challenging clinical skill in intensive care. Educational interventions incorporating patients' perceptions to improve BBN remain scarce in this setting. We aimed to explore intensive care physicians' perceptions of structured patient feedback to improve BBN skills. A quasi-experimental study was conducted with 19 intensive care physicians. Participants received structured patient feedback on their BBN performance after completing a self-reflection activity, were invited to watch an educational video on applying the SPIKES protocol in their practice and planned their next steps for improvement. Semi-structured interviews were conducted after the intervention, and data were analyzed using content analysis. Physicians' perceptions were grouped into four main themes: (1) concepts and roles in BBN, (2) facilitators and barriers, (3) assessment of the intervention, and (4) intervention impacts. Structured feedback fostered reflective practice and helped address communication gaps, including assessing patients' understanding, explaining treatment steps, and adopting an empathetic approach. While positive reinforcement was valued, barriers such as resistance to change and workload limited changes in practice. These findings suggest that structured patient feedback may enhance reflective practice and support the development of BBN skills among intensive care physicians. Structured patient feedback is a promising educational strategy for improving communication in critical care settings, although resistance to change and workload may limit its effectiveness.